Health officials around the world are struggling with a rapidly spreading epidemic of a severe respiratory ailment called SARS (Severe Acute Respiratory Syndrome). China's new government has pledged to deal seriously with an issue that threatens public health, the economy and that nation's image around the world. In Canada, there is concern they could lose the battle to contain the spread of the disease because some people with symptoms are breaking quarantine to wander in public. And in the U.S. there are currently 228 suspected SARS cases in 35 states.

What are the early warning signs of SARS? What precautions should people take? How is it spread?

Stephen S. Morse, director of the Center for Public Health Preparedness at the Mailman School of Public Health at Columbia University, was online Thursday, April 24 at 2 p.m. ET, to discuss SARS detection, treatment and prevention.

Morse is the editor of two books: "Emerging Viruses," selected by "American Scientist" for its list of "100 Top Science Books of the Century" and "The Evolutionary Biology of Viruses."

A transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

Stephen S. Morse: Hi. I'm glad to be here today to discuss SARS.

washingtonpost.com: For the first time in 55 years the World Health Organization has issued a travel warning against visiting the cities of Beijing and Toronto due to SARS. Do you agree with this warning?

Stephen S. Morse: Using travel advisories is an innovative idea, with the intention of being proactive in trying to prevent new outbreaks. There are trade-offs, balancing the trade and political consequences vs. possible health benefits. There hasn't been much experience with this approach, so it is hard to say how effective it will be. This will provide an interesting test case.

New York City: Other than Toronto and Beijing, which have been in the news a lot the past couple of days, what are the other areas in the world you see as being especially at risk for SARS and not advisable for travel?

Stephen S. Morse: At the moment, none (the travel advisories issued by WHO include some other Asia destinations as well, such as Hong Kong).

Washington, D.C.: What can you do during air travel to protect yourself? I'm considering wearing gloves and not using the bathroom!

Stephen S. Morse: Your individual risk is small. No reason to radically change your normal activities! Handwashing and good hygiene are good ideas, as appropriate (no need to compulsively wash hands).

Hyattsville, Md.: There now seems to be some doubt as to whether the coronavirus previously implicated is the true cause of SARS.

What is your opinion based on the evidence so far?

Stephen S. Morse: The best evidence so far suggests a coronavirus as the best candidate at the moment. Some investigators in Canada have suggested that they could not identify this virus in many of their cases. Further studies hopefully will sort this out in the near future.

Washington, D.C.: Seems to me that over the years, flu viruses seem to originate from Asia. Why is this so, and how does that tie in to SARS?

Stephen S. Morse: It has been suggested that pandemic influenza viruses (which cause the "big" flu epidemics) result from reassortment (genetic mixing) between avian and mammalian influenza viruses. Humans are generally fairly resistant to most avian (bird) influenza viruses, but pigs may be more easily infected. It has been suggested that this part of China has a farming system that places ducks (with a wide variety of influenza viruses), pigs, and humans in close contact, allowing new flu reassortants in pigs which may then infect humans nearby. Is there a SARS tie-in? We don't know, but this area does have high population densities of many species as well as humans.

Washington, D.C.: Can you provide some context for the response now being given to SARS? Say in light of how we've handled West Nile, Ebola, or even the severe Influenza epidemic of the early 1900s. Why is this being taken so seriously?

Stephen S. Morse: Ebola has a very high case fatality rate, kills tragically and dramatically, but doesn't spread well from person to person (most cases are in the nearby hospitals in Africa, from poor infection control). Few novel, emerging infections spread from person to person. Any infection that does (like SARS) may have the potential to spread far and quickly, therefore it should be tracked very carefully and controlled early.

Washington, D.C.: Is it safe to purchase and use products that have been manufactured in the Republic of China, such as a coffeemaker. Could an object like this carry the SARS virus on it and transmit it to people here? There has been no discussion in the news about products manufactured in the affected countries and their safety.

Stephen S. Morse: Yes, it should be fine. Even in the unlikely event the virus were there (very unlikely), the virus is not likely to last that long on inanimate surfaces (the shipping may take months), and will be removed when you wash out the coffeepot.

Chicago, Ill.: It seems that hospitalization is a primary means of treating SARS. But how many patients can medical systems absorb, especially since doctors and nurses are among its primary victims? Say SARS continues to spread, how likely is it that hospital systems in Southeast Asia could become completely overwhelmed, leading to a breakout of the disease and a much more massive number of illnesses? Thanks.

Stephen S. Morse: Patients who are not sick enough to require hospitalization should stay home and call their doctors/health care providers (monitor the patient's situation in case more medical attention is needed) -- most people with SARS will recover quickly and completely. Special precautions need to be taken for SARS patients in hospitals (to prevent transmission to the health care workers or other patients), so hospitals could get flooded.

Lanham, Md.: What does SARS stand for?

Stephen S. Morse: Severe Acute Respiratory Syndrome.

Washington, D.C.: I have to go to another part of Canada in two weeks and my stopover is in Toronto. I have to change planes. Should I be concerned? Should I take a mask? Should I try to get another routed flight?

Stephen S. Morse: First, stay informed as the situation in Canada may be different (perhaps better) in two weeks. If feasible, you might wish to change routing if possible, but we have not seen cases from airport contacts.

University Park, Md.: Are the face masks we see people wearing providing a false sense of security? They would have to be properly fitted and have at least an N95 rating to be effective, wouldn't they?

Stephen S. Morse: Yes, I have not generally been recommending masks because it is generally not feasible to wear them all the time and it is impossible to know exactly when you need to wear the mask. I agree that there is a false sense of security that some people get when wearing masks -- to work, they do need to be of the right type and must be properly fitted.

Tulsa, Okla.: Since the virus could survive on inanimate objects, how about currency as a transmission medium?

Stephen S. Morse: Unlikely -- I'd consider the risk very small. (Theoretically possible but I'd say at a low probability.)

Baltimore, Md.: Experts are saying that SARS could potentially become a long-term threat in the world in the same way that the flu and most recently the West Nile Virus have. Is it likely that it would remain as potent, in terms of fatalities if it is not eradicated?

Stephen S. Morse: Prediction is dangerous, as Yogi Berra said, especially when it involves the future. If it has been introduced (say, hypothetically, from another species) in China, or if it has been circulating in the human population there, it could be reintroduced from time to time, so continued vigilance and rapid response is essential. Embers may possibly also remain in some of the places experiencing outbreaks. Impossible to speculate whether how it might change, but hopefully we will learn a great deal from our experiences with this outbreak that will be helpful for the future.

Washington, DC: Dr. Morse,

My calling is public health policy research and I have had the pleasure of working with some of your staff at Mailman in the past.

My question to you is: Do you think the WHO is being too reactionary?

Granted, the communicability rate is relatively high, but given the fact that only 4300 people have been diagnosed with SARS and of those only 250 have died, do you feel the WHO's response is completely justified? In my opinion, they have failed to recognize (if not blatantly ignored) the socioeconomic ramifications of their decisions. The impact on millions of lives (including the current panic in Beijing, the worsening of the economy in Toronto and Ontario Province, and the near death-knell of several air carriers) far exceeds the 5-6%rate of death from infection (which in itself is still far lower than that of most major diseases).

The situation at hand is similar to that of the plague. SARS and its communicability rate are similar to that of plague pneumonia. So why not react to the present situation in a similar fashion (with quarantine, trained investigators, and discretion) rather than with fear and utter inconsequence for the economic devastation and social stigma wrought by rashly imposed edicts?

Much thanks for taking the time to help people understand this disease and thus take control of their fears. Cheers.

Stephen S. Morse: Thanks. I agree it's very important to demystify this. The verdict's not in yet on whether the travel advisories will help. It's an interesting experiment to try to get ahead of the situation, to prevent the infection being brought to new places. Unfortunately, past historical experience has suggested that the devil's in the details here. Also, it is important NOT to stigmatize the affected areas. Even in the "hot spots", individual risk (on a percentage basis) is actually very low.

New York, N.Y.: How long will it take to get a vaccine to combat SARS?

Stephen S. Morse: Hard to say -- in addition to the technical aspects of developing and testing a vaccine (once we're sure we have the right candidate virus), which is ongoing now, a lot of vaccine development and production is economically driven, so part of the answer depends on how big a priority this is. Vaccine development is expensive, and there are relatively few companies and facilities in vaccine production.

Nashville, Tenn.: The Spanish Flu of 1918 killed at least 21 million people in 10 months, perhaps as many as 50 million. Is there any reason that this won't happen with SARS? Is our only hope that it mutates into a less deadly form (which is how the Spanish Flu died out)?

Stephen S. Morse: Luckily, so far SARS has been much less transmissible than the flu.

Baltimore, Md.: How seriously do you take the news coming out of Canada that only 40% of the SARS cases there are actually found to be infected with the coronavirus that has been identified as the cause of SARS? Could the WHO have made the causative virus declaration a little too early?

Stephen S. Morse: Hopefully, this will get sorted out over the next few weeks as more testing is done and as better tests become available. The coronavirus is the best candidate right now, but it remains a working hypothesis. Always important not to jump to conclusions.

New York, N.Y.: How far are we willing to go to contain SARS? As long as people can travel freely then massive infection is possible. A healthy looking passenger with no symptoms can be a carrier, by the time he gets sick he might have infected his wife and kids and so on

Should the U.S. quarantine people coming in from most affected areas?

Stephen S. Morse: So far, the best evidence suggests that transmission occurs during the period when people have symptoms (it is possible to be healthy when getting on the plane and to get sick after arriving, so consult your health care provider if you are feeling sick). But I would people who think they may have SARS (flu-like illness) to be prudent, stay home and avoid travel.

Columbia Md: I had all the early symptoms, except fever was 100 not 100.5, and all symptoms were mild. Symptoms developed after I had spent a weekend at a conference with Canadians and others from around the western world. I now have low level breathing issues. Since I get mild asthma how do I tell the difference? How do I distinguish this from a reaction to any virus?

Stephen S. Morse: If you are feeling flu-like symptoms, call your doctor/health care provider. These symptoms are of course quite common, as we all know, not necessarily SARS.

Knoxville, Tenn: Do we know what the incubation period is for SARS -- how long from exposure until the first symptoms appear?

Stephen S. Morse: Roughly a few days to a week. If you were traveling in an affected area, the rule of thumb is two weeks (if the travel was more than two weeks ago and you're feeling OK, then you're OK).

Turkey: What is the first symptom of SARS?

Stephen S. Morse: It starts as a "flu-like" illness: Fever, dry cough, then may get worse. There is a case definition on the CDC Web site (www.cdc.gov), or WHO Web site (www.who.int)

Stephen S. Morse: Thanks for all the great questions. I enjoyed the dialogue. I have to go now. -- My apologies to those whose questions I couldn't get to -- there were so many excellent questions!

Most of all, keep informed (the WHO and CDC Web sites are very informative, the Washington Post and other papers have been doing a great job covering SARS, for those who want lots of detailed information I also recommend www.promedmail.org). In general, the individual personal risk remains very small -- no need for panic!

Yours for good health,
Steve Morse

washingtonpost.com:

That wraps up today's show. Thanks to everyone who joined the discussion.

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